Presentation on theme: "Electrical Burn Dr. Yasser A. Salem Lecturer of Anesthesia & ICU Ain Shams university."— Presentation transcript:
Electrical Burn Dr. Yasser A. Salem Lecturer of Anesthesia & ICU Ain Shams university
Management of electric burns Initial Assessment & Management Airway Breathing Circulation Disability Expose & Examine History
Initial Assessment & Management Stop the Burning Process Neutralize the heat source Remove smoldering clothing
Airway Assess patency of airway consider the presence of smoke inhalation injury and carbon monoxide toxicity if smoke is present
Breathing Assess adequacy of breathing efforts (is there labored breathing, wheezing?) Remember that the electrical current can impair the ability to breathe Initiate respiratory assistance, if needed
Circulation Electrical burn to muscle acts like a crush injury Shock from heart damage could be seen within minutes IV line placement and fluid administration Cardiac monitoring is indicated with electrical injury CPR and defibrillation per diagnosis and protocol Monitor pulse in extremities with contact point burn or thermal injury; looking for muscle or skin swelling, impairment to local circulation (compartment syndrome)
1966 to articles 65 relevant
Disability Brain and nerve deficits are a common problem Determine status of consciousness and treat accordingly Are all four extremities moving?
Expose & Examine Presence of contact point burns (if present then patient must be transported to a hospital, preferably a burn center due to the risk of the “hidden” injury) Assess for presence of arc or flash burns Assess for other traumatic injuries
History Contact time and exposure Voltage of electrical injury History of other traumatic injury
Components of electric injury First component The injury caused by the electrical current itself. The current generates intense heat often in excess of 2000°F along its path through the body.
Components of electric injury Second component The injury from "arcing". Ionization of air particles associated with a voltage drop is called arcing. The heat generated in the arc can be as high as 4,000°C and can vaporize metal. This process frequently causes a patient’s clothing to ignite and cause flame burns. A form of explosion dissipates excess energy from the arc.
Components of electric injury Third component The skin burn caused by a flash. A flash can result from the power source or from the ignition of clothing or surroundings.
Components of electric injury Fourth component Traumatic injury caused by the intense muscle spasm with the current or from a fall. There is also a variety of cardiac, lung muscle, nerve and internal organ injuries
Types of electric burns 1-High Voltage Injury defined as exposure to a voltage of 1000 volts or greater (damage beneath the surface should be suspected).
Types of electric burns 2-Low Voltage Injury Low Voltage is defined as less than 500 volts (local heat damage is usually evident e.g. at the edge of the mouth in kids biting electric cords) Current not sufficient to cause tissue damage along its course except at contact site Cardiac problems are common e.g. ventricular fibrillation
Important Note The term “entrance and exit” sites are commonly used to describe the damage at a contact point with the electricity. These terms are really a misnomer when describing a high voltage AC current injury as the current is actually passing back and forth between contact with electricity and grounding site on the body. Low-voltage injuries usually only have a small burn (or no damage) at the point of contact.
Injuries caused by high voltage electric burns 1-Injuries along pathway of Current 2-Skin Injury (Contact points) 3-Body Burns 4-Muscle Damage 5-Heart & Blood Vessel Injury 6-Lung Injury 7-Neurologic Injury 8-Orthopedic Injury
1-Injuries along pathway of Current Ventricular Fibrillation Other rhythm abnormalities Respiratory arrest Seizures/Coma Mental changes Hypertension Retinal detachment Cataract (delayed) Muscle necrosis Fractures Hemolysis Renal Failure Hemorrhage Limb loss Anemia Paresis/paralysis etc.
2-Skin Injury (Contact points)
5-Heart & Blood Vessel Injury Immediate cardiac arrest is the most common cause of death. High voltage current has a reported immediate mortality of 60%. The initial heart problems are often reversible with CPR. High blood pressure is also quite common immediately after injury.
6-Lung Injury Impairment of the brain centers stimulation of breathing and severe central nervous system damage Decreased muscle activity in the chest wall caused by a chest burn or muscle damage
7-Neurologic Injury Acute central nervous system damage with coma, seizures, motor and, to a lesser extent, sensory deficits are well described. Many of these abnormalities are permanent.
8-Orthopedic Injury Orthopedic injuries occur as a result of three processes: Muscle spasm-induced fractures and dislocations Heat-induced local bone destruction Devascularizaton of bone
Injuries caused by law voltage electric burns Cardiac Problems Muscle Spasm Oral Burn
Cardiac Problems The most severe injury is electrocution as a household current applied to wet skin is sufficient to cause ventricular fibrillation and cardiac arrest (only 60 milliamps is required). Other rhythm disturbances can also occur.
Muscle Spasm Tetany and spasm can also develop with contact with low voltage. The “can’t let go” current is only 30 milliamps. The spasm in the flexor muscles in the hand and forearm prevents the victim from letting go. Suffocation can also occur if the chest muscles go into spasm as the victim can’t breathe. This problem is most commonly seen with immersion in water like a bath tub.
Oral Burn Low-voltage electricity is the leading cause of electrical injury in children Sucking an extension cord is responsible for more than half of the injuries, and biting on an electric cord accounts for about 30% Bleeding from labial artery at the edge of the mouth is a common occurrence (20%) during the period of slough (7 to 21 days) and should be anticipated. Pressure control of bleeding will be necessary.
Case report Electrical burn J.Y. Yang, Y.C. Tsai,M.S. Noordhoff Department of Plastic Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan 105, Republic of China Accepted 3 September Available online 24 May A 37-year-old female patient suffered high voltage electrical injury with resultant exit wound on the left quadrant of the abdomen measuring 15 × 10 cm 2 involving full thickness of the abdominal wall including the peritoneum. Early debridement and exploratory laparotomy was performed on the fifth post-burn day although the patient had no abdominal symptoms. All visceral organs were grossly normal. The peritoneum was closed and the wound covered with split thickness skin graft. On the twelfth post-burn day the anterior wall of the stomach sloughed and resulted in a 10 × 10cm 2 gastrocutaneous fistula. After 1 month of duodenostomy feeding via the fistula using a Foley catheter, the fistula was closed and was covered with greater omental flap and split thickness skin. Seventeen days later the patient was discharged following an uneventful recovery.
Paraplegia in an electrical burn: a case report A.H.N. Roberts Stoke Mandeville Hospital, Aylesbury, UK Accepted 31 July Available online 31 May A high voltage electrical burn of lung parenchyma M.J Masanès, E Gourbière, J Prudent Accepted 6 March Available online 31 July We report a case of direct electrical injury to the lung parenchyma, without evidence of any thoracic wall contact injury, in an electrician who sustained a 20 kV- electrical shock while working in a substation cubicle. The diagnosis of a true electrical burn of the left lower lobe was suggested early on by imaging and then confirmed by surgical exploration, histological findings and the significant improvement of the patient’s condition following resection of the infarcted lobe. All possible causes of bronchial and pulmonary pathologies in such a context were ruled out. The fatal outcome of two previous similar cases and the generally high mortality of any electrical visceral injury support early surgical management as the only rational life- saving treatment. Current pathophysiological knowledge substantiates the theory of an isolated visceral injury located far away from the contact wounds. However, the pathogenesis of such severe injuries is not entirely understood.